Why Nurses Can’t Read Doctor’s Orders?

Because most doctors cannot hand-write legibly?


 

Iam amazed sometimes how utterly illegible written order’s are. Some are so bad it cannot be deciphered if your life, or your patient’s life depended on it. When you can’t understand an order there is always a nurse on the floor who is familiar with doc’s hieroglyphs.

It goes more or less like this – “Nancy can usually get it,”. So Nancy is requested for the translation job but she is having a bit of difficulty this time, so another nurse comes to help, then another joins the party – it turns into a guessing game. Guessing science is not a good idea.

This is not exclusive of doctors; nurses can also write pretty badly. Writing is not so easy to a lot of people I guess, specially if they are in a hurry. But in medicine writing should be legibly, after all precise and exact instructions need to be communicated.

Bad writing in medicine is irritating because it unsafe and wastes precious time. But to put patients at risk simply because a doctor will not take the time is unacceptable. It takes about 20 – 30 minutes of a nurse’s time to successfully decipher a bad order, including a call to doc.

Badly written orders are dangerous. If a med error is allowed to happen purely because someone was too lazy to write it legibly, is unacceptable. Why do doctors get away with that? It remains a mystery to me.

No one confront doctors on horrific writing skills

Computers are here, ready and available in most places doctors frequent. But instead of writing their order’s in the computer they continue to write their orders in a plain piece of paper perpetuating their calligraphic improprieties. Some hospital did away with that demanding that doctors enter their orders directly into the “orders” tab of each patient. Other places don’t require that.

Doctors strike

The art of translating doctor’s writings

Since the art of doc’s writing is not going away anytime soon, we might as well enjoy it. Deciphering skills involve a mixture of previous experience, knowledge and combining case analysis and probability.

I’m impressed with the skill level some nurses have when it comes to these orders. I have scratched my head for a long time at some. Even offered money to whoever could read it. I’m amazed when a nurse comes by and simply reads it correctly. Crazy to read doc’s orders are part of nursing culture.

When the humor in over however, we are just stuck with having to clarify. It is so nice when you look at a well written order. It shows confidence, peace and tranquility. As if someone speaking to us with a clear, paced and sweet voice.

On the other hand when you see a bunch of senseless scribbles you know there is a nightmare ahead. When you are trying to finish 5 at once, solving a puzzle is the last thing on your list.

For whatever reason doctors have traditionally been horrible at handwriting. But why? Doctors are smart and if they are surgeons, there is no lack of eye-hand coordination. There must be a reason why every physician writes badly.

In every corner of the world it is the same thing so there is obviously a reason behind this phenomenon. It is a sad cosmic joke: “The ones who write the most precise and important messages will have the worst hand writing,” said God laughing. I wish there was an app that could read doctors orders.

Why doctors can’t write legibly?

I scratch my head from time to time trying to figure out why

Here’s one hypothesis 

What I’ve noticed with the medical lexicon is that it is a information dense language. Medical writing is a language within itself. Information come in codes and abbreviations. It is almost like stenography or a distinct language designed for speed and economy. Messages must be concise. On top of that messages are written within the context of the situation.

So in a way you must know the situation at hand to understand the message. The information must be in the note and it does not matter where it is, hence the lack of order. You must find where the important points are because you must already know what the important points are.

In this benevolent theory doctors get away with bad handwriting because we should “kind of know” what they are talking about.

Another hypothesis is that doctors instinctively write strangely so one is always investigating, clarifying and not being sure of what the order actually is. But not being sure one would pay more attention to what’s  been written. This of course is a bad idea. Better would be to write legibly every time.

Conclusion

I heard that a doctor’s handwriting is born in med school. So much information is thrown at them that they have to write fast. Doing that for so long forms a solid habit. At the end of the day, bad writing is bad. Medical orders you cannot understand can create problems ranging from mild annoyance to critical and deadly medical errors. It can be a troublesome and time-consuming ordeal to pharmacists and nurses. Thank God for computers they might save us all. Certainly it would be easier to convert every hospital to EMR than to change this old and established tradition of “bad doctor’s writings”.

But maybe give your doctor friend a nice pen and a calligraphy book just for good measure.

 

 

Image credit: flickr.com

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Marcos Taquechel

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